Meningococcal Vaccine: Protection, Risk, Schedule
Seroquel Xr
Seroquel Xr Generic Name & Formulations General DescriptionQuetiapine (as fumarate) 50mg, 150mg, 200mg, 300mg, 400mg; ext-rel tabs.
Pharmacological ClassDibenzothiazepine.
How SuppliedXR—60; Tabs 25mg, 50mg, 100mg, 200mg, 400mg—100; 300mg—60
StorageStore at 25ºC (77ºF); excursions permitted to 15-30ºC (59-86ºF).
Mechanism of ActionThe efficacy of quetiapine in these indications could be mediated through a combination of dopamine type 2 (D2) and serotonin type 2A (5HT2A) antagonism. The active metabolite, N-desalkyl quetiapine (norquetiapine), has similar activity at D2, but greater activity at 5HT2A receptors, than the parent drug (quetiapine).
Seroquel Xr Indications IndicationsAcute treatment of manic or mixed episodes in bipolar I disorder, as monotherapy and as an adjunct to lithium or divalproex. Depressive episodes associated with bipolar disorder in adults. Maintenance treatment of bipolar I disorder, as an adjunct to lithium or divalproex in adults. Adjunct to antidepressants for major depressive disorder (MDD) in adults.
Seroquel Xr Dosage and Administration AdultSwallow whole. Take on an empty stomach or with light meal. Give once daily in the PM. Mania: 300mg on day 1, then 600mg on day 2, then titrate to effective dose beginning on day 3, usually 400–800mg/day. Maintenance: usual range 400–800mg/day. Depressive episodes due to bipolar disorder: 50mg on day 1, then 100mg on day 2, then 200mg on day 3, then 300mg on day 4; max 300mg/day. Adjunct to MDD: 50mg/day on days 1 and 2, then 150mg/day on day 3, then titrate to effective dose, usual range: 150–300mg/day. Elderly, debilitated, or risk of postural hypotension: titrate more slowly to lower target dose. Elderly or hepatic impairment: initially 50mg/day; may increase at increments of 50mg/day. Concomitant CYP3A4 inhibitors or inducers, reinitiation of treatment: see full labeling. Switching from Seroquel immediate-release: give XR at equivalent total daily dose taken once daily.
ChildrenMania: <10yrs: not established. Swallow whole. Take on an empty stomach or with light meal. Give once daily in the PM. 10–17yrs: 50mg on day 1, then 100mg on day 2, then 200mg on day 3, then 300mg on day 4, then 400mg on day 5; may further increase up to target range of 400–600mg/day; max 600mg/day. Bipolar depression, maintenance: <18yrs: not established.
Seroquel Xr ContraindicationsNot Applicable
Seroquel Xr Boxed Warnings Boxed WarningIncreased mortality in elderly patients with dementia-related psychosis. Suicidal thoughts and behaviors.
Seroquel Xr Warnings/Precautions Warnings/PrecautionsElderly with dementia-related psychosis (not approved use); increased risk of death or cerebrovascular events (eg, stroke, TIA). Increased risk of suicidal thoughts and behavior in children, adolescents, and young adults; monitor closely for worsening or unusual changes in all patients. Exclude neuroleptic malignant syndrome if fever or other symptoms occur. Diabetes. Monitor for hyperglycemia, hyperlipidemia: do fasting blood glucose and lipids testing initially and during therapy. Monitor for weight gain. Cardio- or cerebrovascular disease. Monitor BP in children and adolescents initially and during therapy. Increased risk of QT prolongation (eg, family history, cardiovascular disease, elderly, CHF, heart hypertrophy). Avoid in cardiac arrhythmias (eg, bradycardia), hypokalemia, hypomagnesemia, congenital prolongation of the QT interval. Pre-existing low WBCs or history of leukopenia/neutropenia; monitor CBCs during 1st few months of treatment; discontinue if WBCs decline. Hepatic dysfunction. Seizure risk. Risk of aspiration pneumonia. Exposure to extreme heat. Dehydration. Hypovolemia. Urinary retention. Significant prostatic hypertrophy. Perform fall risk assessments when initiating and recurrently on long-term therapy. Do eye exam initially and every 6 months. History of breast cancer. Reevaluate periodically. Avoid abrupt cessation. Write ℞ for smallest practical amount. Debilitated. Neonates: risk of extrapyramidal and/or withdrawal symptoms post delivery (due to exposure during 3rd-trimester pregnancy). Pregnancy. Nursing mothers.
Seroquel Xr Pharmacokinetics DistributionVolume of distribution: 10±4 L/kg. Plasma protein bound: 83%.
EliminationRenal (~73%), fecal (~20%). Half-life: ~7 hours.
Seroquel Xr Interactions InteractionsAvoid drugs that prolong QT interval including Class 1A (eg, quinidine, procainamide) or Class III antiarrhythmics (eg, amiodarone, sotalol), antipsychotics (eg, ziprasidone, chlorpromazine, thioridazine), antibiotics (eg, gatifloxacin, moxifloxacin), and others (eg, pentamidine, methadone, levomethadyl acetate). Potentiates CNS effects with alcohol (avoid), other CNS depressants. Potentiated by CYP3A4 inhibitors (eg, azole antifungals, indinavir, ritonavir, nefazodone, others); adjust dose. Antagonized by CYP3A4 inducers (eg, phenytoin, carbamazepine, phenobarbital, rifampin, avasimibe, St. John's wort); adjust dose. Potentiates antihypertensives, lorazepam. Antagonizes effects of levodopa, dopamine agonists. Caution with drugs having anticholinergic effects.
Seroquel Xr Adverse Reactions Adverse ReactionsSomnolence, dry mouth, constipation, dizziness, increased appetite, dyspepsia, weight gain, fatigue, dysarthria, nasal congestion, asthenia, abdominal pain, postural hypotension, pharyngitis, lethargy, hyperglycemia, hypothyroidism, hyperprolactinemia; increased ALT (transient), total cholesterol +/or triglycerides; leukopenia, neutropenia, agranulocytosis, intestinal obstruction; rarely: tardive dyskinesia (consider discontinuation), neuroleptic malignant syndrome.
Seroquel Xr Clinical TrialsSee Literature
Seroquel Xr NoteNot Applicable
Seroquel Xr Patient CounselingSee Literature
Seroquel Xr Generic Name & Formulations General DescriptionQuetiapine (as fumarate) 50mg, 150mg, 200mg, 300mg, 400mg; ext-rel tabs.
Pharmacological ClassDibenzothiazepine.
How SuppliedXR—60; Tabs 25mg, 50mg, 100mg, 200mg, 400mg—100; 300mg—60
StorageStore at 25ºC (77ºF); excursions permitted to 15-30ºC (59-86ºF).
Mechanism of ActionThe efficacy of quetiapine in these indications could be mediated through a combination of dopamine type 2 (D2) and serotonin type 2A (5HT2A) antagonism. The active metabolite, N-desalkyl quetiapine (norquetiapine), has similar activity at D2, but greater activity at 5HT2A receptors, than the parent drug (quetiapine).
Seroquel Xr Indications IndicationsSchizophrenia.
Seroquel Xr Dosage and Administration AdultSwallow whole. Take on an empty stomach or with light meal. Initially 300mg once daily in the PM; may increase at 1-day intervals in increments of up to 300mg/day. Usual range: 400–800mg/day; max 800mg/day. Maintenance: 400–800mg/day. Elderly, debilitated, or risk of postural hypotension: titrate more slowly to lower target dose. Elderly or hepatic impairment: initially 50mg/day; may increase in increments of 50mg/day. Concomitant CYP3A4 inhibitors or inducers, reinitiation of treatment: see full labeling. Switching from Seroquel immediate-release: give XR at equivalent total daily dose taken once daily.
Children<13yrs: not established. Swallow whole. Take on an empty stomach or with light meal. Give once daily in the PM. 13–17yrs: 50mg on day 1, then 100mg on day 2, then 200mg on day 3, then 300mg on day 4, then 400mg on day 5; may further increase up to target range of 400–800mg/day; max 800mg/day. Maintenance: <18yrs: not established.
Seroquel Xr ContraindicationsNot Applicable
Seroquel Xr Boxed Warnings Boxed WarningIncreased mortality in elderly patients with dementia-related psychosis. Suicidal thoughts and behaviors.
Seroquel Xr Warnings/Precautions Warnings/PrecautionsElderly with dementia-related psychosis (not approved use); increased risk of death or cerebrovascular events (eg, stroke, TIA). Increased risk of suicidal thoughts and behavior in children, adolescents, and young adults; monitor closely for worsening or unusual changes in all patients. Exclude neuroleptic malignant syndrome if fever or other symptoms occur. Diabetes. Monitor for hyperglycemia, hyperlipidemia: do fasting blood glucose and lipids testing initially and during therapy. Monitor for weight gain. Cardio- or cerebrovascular disease. Monitor BP in children and adolescents initially and during therapy. Increased risk of QT prolongation (eg, family history, cardiovascular disease, elderly, CHF, heart hypertrophy). Avoid in cardiac arrhythmias (eg, bradycardia), hypokalemia, hypomagnesemia, congenital prolongation of the QT interval. Pre-existing low WBCs or history of leukopenia/neutropenia; monitor CBCs during 1st few months of treatment; discontinue if WBCs decline. Hepatic dysfunction. Seizure risk. Risk of aspiration pneumonia. Exposure to extreme heat. Dehydration. Hypovolemia. Urinary retention. Significant prostatic hypertrophy. Perform fall risk assessments when initiating and recurrently on long-term therapy. Do eye exam initially and every 6 months. History of breast cancer. Reevaluate periodically. Avoid abrupt cessation. Write ℞ for smallest practical amount. Debilitated. Neonates: risk of extrapyramidal and/or withdrawal symptoms post delivery (due to exposure during 3rd-trimester pregnancy). Pregnancy. Nursing mothers.
Seroquel Xr Pharmacokinetics DistributionVolume of distribution: 10±4 L/kg. Plasma protein bound: 83%.
EliminationRenal (~73%), fecal (~20%). Half-life: ~7 hours.
Seroquel Xr Interactions InteractionsAvoid drugs that prolong QT interval including Class 1A (eg, quinidine, procainamide) or Class III antiarrhythmics (eg, amiodarone, sotalol), antipsychotics (eg, ziprasidone, chlorpromazine, thioridazine), antibiotics (eg, gatifloxacin, moxifloxacin), and others (eg, pentamidine, methadone, levomethadyl acetate). Potentiates CNS effects with alcohol (avoid), other CNS depressants. Potentiated by CYP3A4 inhibitors (eg, azole antifungals, indinavir, ritonavir, nefazodone, others); adjust dose. Antagonized by CYP3A4 inducers (eg, phenytoin, carbamazepine, phenobarbital, rifampin, avasimibe, St. John's wort); adjust dose. Potentiates antihypertensives, lorazepam. Antagonizes effects of levodopa, dopamine agonists. Caution with drugs having anticholinergic effects.
Seroquel Xr Adverse Reactions Adverse ReactionsSomnolence, dry mouth, constipation, dizziness, increased appetite, dyspepsia, weight gain, fatigue, dysarthria, nasal congestion, asthenia, abdominal pain, postural hypotension, pharyngitis, lethargy, hyperglycemia, hypothyroidism, hyperprolactinemia; increased ALT (transient), total cholesterol +/or triglycerides; leukopenia, neutropenia, agranulocytosis, intestinal obstruction; rarely: tardive dyskinesia (consider discontinuation), neuroleptic malignant syndrome.
Seroquel Xr Clinical TrialsSee Literature
Seroquel Xr NoteNot Applicable
Seroquel Xr Patient CounselingSee Literature
Comments
Post a Comment